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Published on: June 12, 2021
Application of the Updated Cardiogenic Shock Working Group SCAI Classification for Cardiogenic Shock: A Single-Centre
Monte Scott1, Christos P Kyriakopoulos2, Eric Sheffield3
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Health and School of Medicine, Salt Lake City, Utah, USA. Electronic address: https://twitter.com/Scott.
Insights
The Society for Cardiovascular Angiography and Interventions-Cardiogenic Shock Working Group (SCAI-CSWG) classification effectively predicts in-hospital mortality in patients with cardiogenic shock (CS). Higher SCAI-CSWG stages correlate with increased mortality rates, underscoring its clinical utility.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Outcomes Research
Background:
- The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a cardiogenic shock (CS) severity classification in 2019.
- The Cardiogenic Shock Working Group (CSWG) refined this classification in 2022 to improve CS stratification.
Purpose of the Study:
- To evaluate the in-hospital mortality rates across different severity stages of cardiogenic shock (CS) using the SCAI-CSWG classification.
- To assess the utilization of temporary mechanical circulatory support based on CS severity.
Main Methods:
- Retrospective analysis of 742 consecutive patients with CS managed at a quaternary academic medical center (May 2015 - December 2021).
- In-hospital mortality and temporary mechanical circulatory support use were assessed per SCAI-CSWG stage at shock onset.
- Included devices: intra-aortic balloon pump, percutaneous ventricular assist device, and venoarterial extracorporeal membrane oxygenation.
Main Results:
- In-hospital mortality increased with higher SCAI-CSWG stages: 14.30% (Stage B), 20.90% (Stage C), 32.70% (Stage D), and 44.80% (Stage E).
- Temporary mechanical circulatory support use was highest in the most severe SCAI stage (Stage E).
- The cohort had a median age of 62 years, predominantly male (66%), with 25% acute myocardial infarction and 75% non-acute myocardial infarction as CS etiology.
Conclusions:
- A direct relationship exists between in-hospital mortality and cardiogenic shock severity as defined by the SCAI-CSWG classification.
- These findings support the SCAI-CSWG classification's utility in predicting outcomes for CS patients.
- Further validation through prospective studies is warranted.
Background:
In 2019, the Society for Cardiovascular Angiography and Interventions (SCAI) proposed an algorithm to assess cardiogenic shock (CS) severity, known as SCAI classification. In 2022, the Cardiogenic Shock Working Group (CSWG) modified the original classification using specific parameters to better define hypotension and hypoperfusion with the goal to further refine stratification.
Methods:
Consecutive patients with CS who were managed at a quaternary academic medical centre from May 2015 to December 2021 were evaluated (N = 1162). Our study cohort comprised patients who developed CS after admission. In-hospital mortality per SCAI stage at shock onset was assessed. The percentages of temporary mechanical circulatory support use per SCAI stage at shock onset was also reported. In our study, we included intra-aortic balloon pump, percutaneous ventricular assist device, and venoarterial extracorporeal membrane oxygenation.
Results:
Our study cohort comprised 742 patients with a median age of 62.0 (interquartile range, 51-72) years, mostly men (66%). Etiology of CS included 25% acute myocardial infarction and 75% non-acute myocardial infarction. In-hospital mortality per CS severity stage using the SCAI-CSWG classification was 14.30% for stage B, 20.90% for stage C, 32.70% for stage D, and 44.80% for stage E, whereas temporary mechanical circulatory support use was greatest in SCAI stage E.
Conclusions:
We identified a direct relationship of in-hospital mortality per CS severity stage using the SCAI-CSWG classification in the overall cohort. These findings require further validation in prospective studies.
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